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Annals of the Royal College of Surgeons... May 2018A concise review of the use of robotic technology to enhance surgery (Review)
Review
A concise review of the use of robotic technology to enhance surgery
Topics: General Surgery; History, 20th Century; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Robotic Surgical Procedures; Robotics
PubMed: 29717892
DOI: 10.1308/rcsann.supp1.5 -
Annals of Surgery Jul 2018The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical...
OBJECTIVE
The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery.
BACKGROUND
The exponential growth of laparoscopic liver surgery in recent years mandates the development of clinical practice guidelines to direct the speciality's continued safe progression and dissemination.
METHODS
A unique approach to the development of clinical guidelines was adopted. Three well-validated methods were integrated: the Scottish Intercollegiate Guidelines Network methodology for the assessment of evidence and development of guideline statements; the Delphi method of establishing expert consensus, and the AGREE II-GRS Instrument for the assessment of the methodological quality and external validation of the final statements.
RESULTS
Along with the committee chairman, 22 European experts; 7 junior experts and an independent validation committee of 11 international surgeons produced 67 guideline statements for the safe progression and dissemination of laparoscopic liver surgery. Each of the statements reached at least a 95% consensus among the experts and were endorsed by the independent validation committee.
CONCLUSION
The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts' knowledge taking in consideration the relevant stakeholders' opinions and complying with the international methodology standards.
Topics: Delphi Technique; Europe; Hepatectomy; Humans; Laparoscopy; Liver Diseases
PubMed: 29064908
DOI: 10.1097/SLA.0000000000002524 -
Science Robotics Jan 2022Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of individual surgeon's skill and experience. Autonomous... (Comparative Study)
Comparative Study
Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of individual surgeon's skill and experience. Autonomous anastomosis is a challenging soft-tissue surgery task because it requires intricate imaging, tissue tracking, and surgical planning techniques, as well as a precise execution via highly adaptable control strategies often in unstructured and deformable environments. In the laparoscopic setting, such surgeries are even more challenging because of the need for high maneuverability and repeatability under motion and vision constraints. Here we describe an enhanced autonomous strategy for laparoscopic soft tissue surgery and demonstrate robotic laparoscopic small bowel anastomosis in phantom and in vivo intestinal tissues. This enhanced autonomous strategy allows the operator to select among autonomously generated surgical plans and the robot executes a wide range of tasks independently. We then use our enhanced autonomous strategy to perform in vivo autonomous robotic laparoscopic surgery for intestinal anastomosis on porcine models over a 1-week survival period. We compared the anastomosis quality criteria-including needle placement corrections, suture spacing, suture bite size, completion time, lumen patency, and leak pressure-of the developed autonomous system, manual laparoscopic surgery, and robot-assisted surgery (RAS). Data from a phantom model indicate that our system outperforms expert surgeons' manual technique and RAS technique in terms of consistency and accuracy. This was also replicated in the in vivo model. These results demonstrate that surgical robots exhibiting high levels of autonomy have the potential to improve consistency, patient outcomes, and access to a standard surgical technique.
Topics: Algorithms; Anastomosis, Surgical; Animals; Digestive System Surgical Procedures; Humans; Intestine, Small; Laparoscopy; Machine Learning; Motion; Phantoms, Imaging; Robotic Surgical Procedures; Suture Techniques; Swine
PubMed: 35080901
DOI: 10.1126/scirobotics.abj2908 -
Polski Przeglad Chirurgiczny Mar 2021Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with...
INTRODUCTION
Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with laboratory and imaging methods, and an invasive procedure such as diagnostic laparoscopy may be required to obtain a diagnosis. Diagnostic laparoscopy is also performed therapeutically, but laparotomy is inevitable in some cases. The aim of the study is to evaluate the role of diagnostic laparoscopy in diagnosis and treatment and to retrospectively examine the factors that force the surgeon to perform a laparotomy.
MATERIAL AND METHODS
Patients over the age of 18 who underwent diagnostic laparoscopy in the general surgery clinic of Sakarya University Training and Research Hospital between January 2013 and December 2019 were retrospectively evaluated. Patients under 18 years of age and patients diagnosed before surgery were excluded. Demographic data of the patients, whether there was a conversion from laparoscopy to laparotomy, postoperative morbidity, and mortality were recorded.
RESULTS
The data of 347 patients in total were evaluated retrospectively between the specified dates. 216 of the patients were previously diagnosed, laparoscopic procedures performed for staging purposes and they were not included in the study. The remaining 131 patients were included in the study. 68 of the patients were women and 63 were men. 79.4% of the patients were diagnostic laparoscopies performed due to emergency circumstances, and 20.6% for abdominal pain evaluation. While the procedure was concluded laparoscopically in 64.9% of the patients, the operation was continued by performing laparotomy in 35.1%.
CONCLUSION
Despite the increase in the variety and frequency of use of imaging modalities, a laparoscopic intervention is an essential approach in both diagnosis and treatment when the diagnosis is doubtful, especially in emergency cases in appropriate cases.
Topics: Abdomen; Abdominal Pain; Adolescent; Adult; Female; Humans; Laparoscopy; Laparotomy; Male; Retrospective Studies
PubMed: 33949333
DOI: 10.5604/01.3001.0014.8220 -
AMA Journal of Ethics Aug 2023The surgical platform for robotic-assisted surgery has enabled many surgeons to join a popular trend in minimally invasive surgery, which offers prospective benefits to...
The surgical platform for robotic-assisted surgery has enabled many surgeons to join a popular trend in minimally invasive surgery, which offers prospective benefits to patients (eg, shorter hospital stays, earlier recovery, and less pain) and operational benefits to surgeons. Surgeons without minimally invasive surgical training typically acquired during fellowship training are generally able to perform complex procedures with the robotic platform due to its ergonomic suturing instrumentation, tremor stabilization, 3D visualization, and 4-arm control by a single surgeon. Prospective benefits, however, must be balanced against prospective risks. This article explores the multitude of factors that persuade both surgeons and patients to choose robotic surgery over open surgery or conventional laparoscopy and explores whether evidence exists to support its use despite sometimes conflicting research.
Topics: Humans; Robotic Surgical Procedures; Surgeons; Minimally Invasive Surgical Procedures; Laparoscopy; Pain
PubMed: 37535504
DOI: 10.1001/amajethics.2023.598 -
Acta Cirurgica Brasileira 2019To describe a guide for the construction of a laparoscopic training simulator.
PURPOSE
To describe a guide for the construction of a laparoscopic training simulator.
METHODS
Step-by-step description of an inexpensive and easy to assemble homemade laparoscopic training box, capable of simulating the laparoscopic environment in its peculiarities to enable technical skills training.
RESULTS
The total cost of the materials for the construction of the simulator was US$ 75.00 (about R$ 250.00 "reais") and it can be reduced to US$ 60.00 if the builder judges that there is no need for internal lighting. The use of real trocars imposes the same challenges as real surgeries regarding positioning, visibility and limitation of movements.
CONCLUSION
The proposed economical and efficient alternative can contribute to the teaching and practice of laparoscopic surgical technique worldwide, benefiting surgeons and patients.
Topics: Clinical Competence; Education, Medical; Humans; Laparoscopy; Models, Anatomic; Reproducibility of Results; Simulation Training
PubMed: 31826149
DOI: 10.1590/s0102-865020190100000006 -
JSLS : Journal of the Society of... 2014Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the... (Review)
Review
BACKGROUND
Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the potential for subcutaneous emphysema is necessary for safe laparoscopy.
METHODS
A literature review and a PubMed search are the basis for this review.
CONCLUSIONS
The known risk factors leading to subcutaneous emphysema during laparoscopy are multiple attempts at abdominal entry, improper cannula placement, loose fitting cannula/skin and fascial entry points, use of >5 cannulas, use of cannulas as fulcrums, torque of the laparoscope, increased intra-abdominal pressure, procedures lasting >3.5 hours, and attention to details. New additional risk factors acting as direct factors leading to subcutaneous emphysema risk and occurrence are total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Recognizing this spectrum of factors that leads to subcutaneous emphysema will yield greater patient safety during laparoscopic procedures.
Topics: Humans; Laparoscopy; Pneumoperitoneum, Artificial; Risk Factors; Subcutaneous Emphysema
PubMed: 24680136
DOI: 10.4293/108680813X13693422520882 -
International Journal of Surgery... Sep 2016The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently,... (Review)
Review
OBJECTIVE
The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently, laparoscopic surgery has been accepted as a minimally invasive treatment to reduce the morbidity after conventional surgery, and a number of studies have demonstrated the feasibility of laparoscopy with significant advantages also in the elderly. On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics. This paper will review the physiopathological implications of laparoscopy, as well as the current literature concerning the most common laparoscopic procedures that are increasingly performed in elderly patients.
MATERIALS AND METHODS
A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting the physiopathological implications of laparoscopy in the elderly. The MeSH search terms used were "laparoscopy in the elderly", "physiopathology of laparoscopy", and "pneumoperitoneum". Multiple combinations of the keywords and MeSH terms were used with particular reference to elderly patients.
RESULTS
Although laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands present particular challenges among elderly patients.
CONCLUSIONS
Laparoscopy and its safety in the elderly patients remains a challenge and the evaluation of this approach is therefore mandatory. Although many studies have demonstrated the applicability and advantages of the laparoscopy also in the geriatric population, with low rates of morbidity and mortality, in elderly patients undergoing general surgical procedures the physiologic demands of laparoscopy should be carefully considered.
Topics: Abdominal Wall; Aged; Carbon Dioxide; Health Services for the Aged; Humans; Italy; Laparoscopy; Postoperative Complications
PubMed: 27255126
DOI: 10.1016/j.ijsu.2016.05.044 -
Polski Przeglad Chirurgiczny Oct 2018Major Vascular injury during laparoscopy is most deadly complication of laparoscopy. This report is review major vascular injuries based on surgeon's relation and... (Review)
Review
Major Vascular injury during laparoscopy is most deadly complication of laparoscopy. This report is review major vascular injuries based on surgeon's relation and literature. The incidence of MVI is 0,04-0,1%. Extremely important is to learn proper technique of insuflation. According to patient's physique surgeon should consider best technique of insuflation, take caution against slim people, and induct implements with proper angle. We should avoid excesive force during trocar and Verres's needle insertion, we also should avoid redundant movement after Verres needle is inserted in abdomen cavity. Elevation of the anterior abdominal wall at the time of Veress or primary trocar insertion is routinely recomended. Major vascular injury is seriously underestimated problem of laparoscopic operations.
Topics: Humans; Intraoperative Complications; Laparoscopy; Vascular System Injuries
PubMed: 31481639
DOI: 10.5604/01.3001.0012.6659 -
Journal of Nippon Medical School =... Sep 2019Before the first laparoscopic hepatectomy (LH) was described in 1991, open hepatectomy (OH) was the only choice for surgical treatment of liver tumors. LH indications... (Review)
Review
Before the first laparoscopic hepatectomy (LH) was described in 1991, open hepatectomy (OH) was the only choice for surgical treatment of liver tumors. LH indications were initially based solely on tumor location, size, and type. Use of LH has spread rapidly worldwide because it reduces incision size. This review systematically assesses the current status of LH. As compared with OH, LH is significantly less complicated, requires shorter hospital stays, and results in less blood loss. The long-term survival rates of LH and OH are comparable. Development of new techniques and instruments will improve the conversion rate and reduce complications. Furthermore, development of surgical navigation will improve LH safety and efficacy. Laparoscopic major hepatectomy for HCC remains a challenging procedure and should only be performed by experienced surgeons. In the near future, a training system for young surgeons will become mandatory for standardization of LH, and LH will likely become better standardized and have broader applications.
Topics: Blood Loss, Surgical; Carcinoma, Hepatocellular; Hepatectomy; Humans; Laparoscopy; Length of Stay; Liver Neoplasms; Postoperative Complications; Survival Rate
PubMed: 31204380
DOI: 10.1272/jnms.JNMS.2019_86-411